Provider Demographics
NPI:1801536131
Name:OHARA, KRISTEN SHANNA
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SHANNA
Last Name:OHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NORTHPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1276
Mailing Address - Country:US
Mailing Address - Phone:816-838-4247
Mailing Address - Fax:
Practice Address - Street 1:19 N WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1747
Practice Address - Country:US
Practice Address - Phone:550-348-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021048320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health